Epidural anesthesia is a form of local anesthesia in which local anesthesia is injected through a needle placed in the low, middle part of the back. Very often, a small, soft, long plastic tube is placed through the needle into the back, and left in place after the needle is removed. The tube, called an epidural catheter, is brought up, over the shoulder and taped to the back. The advantage of using an epidural catheter is that local anesthesia can be added through the catheter as often as desired to maintain comfort as long as needed.
Epidural catheter anesthesia cant wear off before the surgery is done.
Epidural anesthesia causes numbness and weakness in the legs and abdomen and sometimes into the lower chest. It is very important to know that leg weakness is an expected and normal part of epidural anesthesia. You wont be able to wiggle your toes, lift your knees or move at all while your epidural anesthetic is working.
Epidural anesthesia by itself will not make you sleepy. Usually sedative medicine is given through the intravenous. Often this combination allows patients to be totally unaware of surgery. Occasionally the anesthesiologist may be unable to safely sedate to unawareness. In this case the patient may be a little aware of some of the sites and sounds of surgery. If you want to be asleep and your anesthesiologist doesnt sedate you to sleep, hes not being cruel, hes trying to keep you safe, and believes you cant be safely sedated to sleep. Because epidural anesthesia provides perfect comfort, it is possible to remain totally alert if you wish. Patients are discouraged from watching their own surgery.
The epidural anesthesia is started after the patient is on the operating room table with blood pressure cuff, heart monitor, pulse oximeter, oxygen cannula gently attached. The patient is often sedated some, then asked to turn on the side or to sit. A nurse assistant helps to support and position. Please help the nurse as much as you can. A good position is very important to helping the needle easily find the right location! The anesthesiologist and assistant will tell you each thing that they are going to do so that there will be no surprises. You will find that having the needle inserted and the catheter installed is easier than what you expect. After washing the skin with some brown solution on a sponge, the doctor will push on your back with his fingers, then put some local anesthetic under the skin with a tiny needle. This injection will burn some, and is usually the most uncomfortable part of the procedure. After this you will feel pushing as the needle is inserted. After the needle is inserted, local anesthesia is injected. Often the patient is unaware of this, but occasionally they report a "strange" feeling and rarely some discomfort. If a catheter is used, it is passed through the needle. Usually this too is unnoticed by the patient. Occasionally the patient feels a slight discomfort. After this the needle is painlessly removed. If a catheter has been used it is secured to the back with clear plastic film.
Side effects of epidural anesthesia include shivering, and nausea. Unpleasant, but not dangerous. Complications include: spinal headache, low backache, and a very tiny chance of permanent nerve damage such that some part of you doesnt feel or move normally again. Epidural anesthesia has a very good safety record. For some patients having some surgeries it will be safer than general anesthesia. For most patients and most surgical procedures the risks of epidural and general anesthesia are about the same.